Covid 19 coronavirus: Pathway out of alert level 4 is critical

If the Government’s decision to suspend most of the economy and send most Kiwis home for a month is successful, I will be one of the first to applaud. Covid-19 has cast me in the role of a vulnerable New Zealander.

For more than a decade I have been living with chronic lung disease. Thanks to daily medication, my illness barely impairs my life. But my doctor’s warning about catching coronavirus was bleak. Fortunately, I can work from home, and I was in self-enforced isolation a fortnight before the Government moved to Alert Level 4. I am likely to stay that way long after the lockdown is relaxed.

For the tens of thousands of Kiwis who, like me, might have succumbed to Covid-19, New Zealand’s geographical isolation is an opportunity most other OECD countries don’t have. Eradicating Covid-19 during four-weeks of hibernation may allow Kiwis to avoid the health catastrophes of Italy, the US and the UK. And it will save the lives of thousands of New Zealanders. We should all be holding our collective breath hoping it works.

But if it doesn’t, Plan B becomes critical. The country cannot stay in lockdown indefinitely. Already it has come at a huge cost as many businesses haemorrhage jobs.

Economists tend to talk about economic effects as percentages of GDP. In the case of the lockdown, the percentages are eye-watering. However, this measurement is too abstract for what is happening in the real economy. Job losses and business failures are the concrete outcome of the shutdown.

Just as a virus spreads through a population exponentially, shutting down the economy has set off a chain reaction affecting business after business and worker after worker. Economists predict upwards of 20% of New Zealand workers could end up unemployed if the lockdown persists. Not since the Great Depression has New Zealand seen unemployment levels like this.

With the recently unemployed forced to stay home, we have been sheltered from seeing tens of thousands in queues outside Work and Income for the unemployment benefit. But we are soon to be confronted with the numbers involved, with the Ministry of Social Development this week promising to release monthly applications for the dole. None of us will be unaffected. Soon we will all have an unemployed family-member or friend. And it will take a generation for the scars to heal if unemployment and business failures reach levels rivalling the Great Depression.

Last week, the Director-General of Health Ashley Bloomfield said the Government didn't have a plan B if the lockdown fails. But his suggestion that New Zealand will stay in lockdown indefinitely is untenable. Our Government must understand that wellbeing requires a broader assessment than the epidemiological one. At some point, the harm to wellbeing from locking down our economy will exceed the wellbeing benefits of continuing it.

With unemployment numbers skyrocketing, this week’s Economist magazine described the decision about whether to extend shutdowns as a “grim calculation” for governments. The trade-off pits human deaths from the virus against harm to thousands of workers and their families from likely long-term unemployment. Could there be a more difficult public policy choice?

Fortunately, the lessons from other countries suggest the calculus need not be so gloomy – at least, not for New Zealand.

While epidemiologists have widely criticised the Ministry of Health’s narrowly focused testing regime, to date its testing implies the virus has not taken hold in the community. This could be due to the ministry’s testing myopia. As testing is belatedly ramped-up, recent results still do not show widespread community transmission, but it is remains unclear why 18% of current cases are still “unexplained.”

Higher levels of testing may be justified as we come out of lockdown. As of Sunday, New Zealand had conducted 7500 tests per million of population. While comparable with several other small, advanced OECD countries, this is a significantly lower rate than Australia (11,653 tests per million) and Hong Kong (12,900 tests per million). Following the advice of the World Health Organisation (WHO) head, Tedros Adhanom Ghebreyesus three weeks ago to “Test, test, test,” those overseas benchmarks suggest more testing can be done.

We can also strengthen our contact tracing for known Covid-19 cases. The Ministry of Health says it now has the capacity to trace 700 contacts a day. Yet Singapore, with a population of 5.8 million (a million extra people than New Zealand), can trace up to 4000 contacts a day.

Built on experience with successive epidemics like SARS in 2003 and Swine flu in 2009, Singapore also uses serological testing to detect Covid-19 antibodies in a patient’s contacts. This allows the Singaporean health authorities to track the transmission of the virus even among contacts who have recovered. And Singapore does not hesitate to use “big data” to prepare a digital footprint of anyone confirmed to have had Covid-19 to boost its contact-tracing. The free mobile app, TraceTogether, allows Singapore to track about a million users’ proximity to high-risk individuals using Bluetooth. New Zealand’s Ministry of Health is investigating this option.

South Korea and Taiwan also offer good examples for community-wide use of facemasks. In these countries, facemask wearing in public is either compulsory or strongly recommended, and neither has been forced into a lockdown. Last week the US Centres for Disease Control and Prevention changed tack and recommended that Americans start covering their face when leaving home. For now, our Government is awaiting information from the WHO about how effective face masks are before telling Kiwis to wear them. A change of practice is surely imminent.

What about the border? Looking again to Singapore, all returning residents must comply with a legally enforceable 14-day stay-home notice, which forbids them even from shopping. They must also report their health status to the authorities at least three times a day. Those infected with the virus must quarantine in hospital and cannot self-isolate at home. Strict penalties apply to anyone breaching these requirements.

As we approach the mid-point of our four-week lockdown, international experience provides important lessons about “what’s next?” The evidence from South Korea and Taiwan suggests that if we get everything else right, easing back to Level 3 should be feasible.

An East Asia-style Plan B will be risky – but so is the alternative. The Director-General of Health may not have a competency in economics but getting people back to work at the earliest opportunity is its own wellbeing imperative. Especially when we can continue to keep the old and other vulnerable people, like me, in isolation.

A zealous lockdown-or-nothing approach risks the treatment becoming worse than the disease.